Provider Demographics
NPI:1487602553
Name:ANSARI, ANIS U (MD)
Entity type:Individual
Prefix:DR
First Name:ANIS
Middle Name:U
Last Name:ANSARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 13TH AVE N
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-5067
Mailing Address - Country:US
Mailing Address - Phone:563-243-2511
Mailing Address - Fax:563-243-0817
Practice Address - Street 1:915 13TH AVE N
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-5067
Practice Address - Country:US
Practice Address - Phone:563-243-2511
Practice Address - Fax:563-243-0817
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA29411207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
19975OtherIOWA HEALTH SOLUTIONS
043663OtherHEALTH ALLIANCE
2418OtherMIDLANDS CHOICE
49180OtherWELLMARK BC/BS
IA0177OtherJOHN DEERE HEALTH
IL036083530Medicaid
IA5107375Medicaid
49180OtherWELLMARK BC/BS
IA49180Medicare PIN
19975OtherIOWA HEALTH SOLUTIONS